Medical insurance is a necessity, especially in emergencies and uncertain times. However, you also need to take into account exclusions—provisions in your insurance policy that remove coverage for certain types of risks—when evaluating the extent of your insurance coverage. If you want to widen your insurance coverage without having to switch insurance providers, there’s the option of getting supplemental insurance, which is separate from your medical insurance.
Is a separate plan worth your money? The short answer would be it depends on the extent of the policy’s coverage and whether it meets your needs. Clearfinity Eyecare Optometrist, your trusted optometrist, explains in this guide what a vision insurance plan usually covers and shares tips on evaluating a policy’s coverage.
What’s Usually Covered Under a Standard Vision Insurance Plan
A standard vision insurance plan usually pays a portion of the costs of eyeglasses, contact lenses, eye exams, vision tests, and other forms of preventive eye care. Some insurance providers also offer coverage for disposable contacts and discounts on corrective eye surgery as additional options.
Is a Vision Insurance Plan Worth the Cost?
Given that 66% of Americans aged 18 and above need eyeglasses, contact lenses, or both, a lot of patients would benefit from getting vision insurance. Patients who need eyeglasses would certainly find value in the partial inclusion of eye exams in the plan coverage. As a rule of thumb, patients aged between 18 and 60 should see an optometrist at least once every two years. But if they’re aged over 60 or wear eyeglasses or contacts, you need to undergo an eye exam at least once every year to monitor changes in their vision. However, if you only need routine eye exams, supplementary vision insurance isn’t the most cost-effective choice.
Keep in mind that factors such as eye injuries and a family history of diseases such as diabetes—which increase your risk of developing certain vision conditions—can also increase the frequency of eye exams. If you meet the aforementioned criteria or need corrective eyewear and preventive eye care, the additional coverage provided by a vision insurance plan would certainly be worth the cost.
Choosing an Insurance Vision Plan
The coverage offered by a vision insurance plan varies depending on the insurer, which is why you should compile a shortlist of insurance providers and list down the details of their vision insurance plans. To make sure your getting value for your money, look for insurance providers that:
- Offers plans in your area
- Covers your preferred optometrist or eye specialist (Check the provider directory to see if your eye doctor is accredited)
- Offers plans that don’t have waiting periods (if you need to undergo an eye exam or see an eye specialist as soon as possible)
- Offers combination plans (if you need other forms of supplementary insurance, like dental insurance)
Important note: Keep in mind that vision insurance plans are different from vision discount plans. As the name suggests, discount plans only give discounts on vision care and, as such, are less expensive than vision insurance plans.
Understanding an Insurance Plan’s Coverage
Once you’ve compiled a list of insurance, you need to go through the details of each plan and see if it can cover all of your eye care needs. Take note that insurers focus on the reason for your visit to the eye specialist when assessing a claim. For instance, suppose you went to your eye doctor to update the prescription for your eyeglasses. However, during the eye examination, they noticed warning signs of glaucoma, a leading cause of blindness among adults over the age of 60. Since you originally went to the eye doctor for an eye exam, the cost of the visit will be covered under your vision insurance plan. However, since your eye doctor made a diagnosis at the end of your visit, subsequent tests needed to confirm the eye specialist’s initial diagnosis will be covered under your medical insurance policy.
If you have any additional questions about the vision insurance plan, you should contact the insurance provider.
The Cost of a Vision Insurance Plan
Companies usually provide vision insurance plans to their employees as part of their benefits package. The total costs will vary depending on the insurance provider. But in general, the higher the premium you have to pay, the less you’ll have to pay out-of-pocket for vision care services.
Understanding Your Risk for Diseases
Before making a decision on your insurance coverage, it’s essential that patients understand the importance of preventive eye care as well as their risks for certain diseases. As mentioned earlier, genetic factors or family history can increase your risk for certain conditions.
Common eye conditions with strong genetic links include:
- Glaucoma – Glaucoma is a term that refers to a group of eye conditions that can damage your optic nerve and cause blindness. There are three types: open-angle glaucoma (which is caused by clogged drainage canals that increase eye pressure), angle-closure glaucoma (develops when the iris bulges and blocks the drainage angle and, in the process, cuts off circulation and increases eye pressure), and normal-tension glaucoma (the causes of this condition are still unknown).
Risk factors: Patients with a family history of glaucoma are nine times more likely to develop the condition. Aside from genetics, other risk factors include age (patients aged over 60 are six times more likely to develop glaucoma), conditions affecting your blood flow (e.g., migraines, diabetes, low blood pressure, and hypertension), steroid use (some studies have noticed a link between steroid use and glaucoma), and previous eye injuries (eye trauma can damage the drainage systems and increase the risk of secondary open-angle or traumatic glaucoma). The symptoms of glaucoma progress gradually, which is why early detection is essential to treating the condition.
- Age-related macular degeneration (AMD) – As the name suggests, AMD affects the macula—the central part of the retina—and central vision, which is essential to your ability to read and drive. Genetics, along with age (AMD is common among patients aged 50 and above) and smoking, is a significant risk factor. It’s estimated that a patient is three to four times more likely to develop AMD if there’s a family history of the disease.
Important note: Like glaucoma, age-related macular degeneration doesn’t produce noticeable symptoms in its early stages. However, as the condition progresses, patients may notice a blurry area near the center of their vision that will become larger. If you have a family history of AMD, you need to undergo a dilated eye exam at least once every year to detect the early warning signs.
The Importance of Preventive Eye Care and a Healthy Lifestyle
Aside from undergoing routine eye exams, there’s little you can do to reduce genetic risk factors. However, making lifestyle changes can help reduce non-genetic risk factors. Here are some lifestyle tips:
- Quit smoking – Quitting smoking lowers your risk of developing age-related macular degeneration by two to three times. If you’re having trouble kicking the habit, formulating a health plan with your optometrist or joining a support group can help.
- Moderate exercise – Following an exercise routine can help lower intraocular pressure, which is one of the main causes of glaucoma.
- Incorporate more fruits, vegetables, nuts, and cold – water fish into your diet – Nutrients such as zinc, copper, selenium, and vitamins C, E, and A, can help prevent glaucoma from progressing while Omega 3s can help lower your risk of developing AMD.
To learn more about your risk for developing certain diseases, you can consult your eye doctor the next time you undergo an eye exam to update the prescription for your eyeglasses.
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